Provider Demographics
NPI:1669695615
Name:MUSGRAVE, ERNEST EUGENE SR (MEDICAL DOCTOR)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:EUGENE
Last Name:MUSGRAVE
Suffix:SR
Gender:M
Credentials:MEDICAL DOCTOR
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Mailing Address - Street 1:CONVENIENCIA ST 1402
Mailing Address - Street 2:SUITE 701
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-724-5238
Mailing Address - Fax:787-724-5238
Practice Address - Street 1:CONVENIENCIA ST #1402
Practice Address - Street 2:SUITE 701
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-724-5238
Practice Address - Fax:787-724-5238
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
PRLIC 04421207R00000X
PR04421207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR26483Medicare ID - Type Unspecified
D08378Medicare UPIN